Haglund deformity is characterized by a prominent bump at the back top part of the heel bone (calcaneus). This condition can lead to inflammation and pain on the anterior surface of the retrocalcaneal bursa and Achilles tendon due to mechanical irritation, ultimately resulting in insertional Achilles tendinopathy. If conservative treatment methods such as shoe modification, physical therapy, and shockwave therapy fail to alleviate the pain, surgical intervention is recommended.
Haglund deformity and chronic Achilles tendinitis are two common conditions that cause pain, limited movement, and discomfort in the heel bone and Achilles tendon areas. When conservative methods are insufficient, surgical interventions emerge as an effective treatment option.
• Haglund Deformity: A bony bump that occurs at the back-top part of the heel bone, causing inflammation and pain by exerting pressure on surrounding tissues.
• Chronic Achilles Tendinitis: Inflammatory and degenerative changes occur in the Achilles tendon due to repetitive microtraumas. This condition leads to tendon thickening, sensitivity, and functional loss.
In cases where conservative methods fail, surgical treatment provides an effective solution to control symptoms. The mentioned surgical options are as follows:
This procedure is a minimal invasive surgical method used to treat Haglund deformity.
• Purpose: To remove the bone bump and the retrocalcaneal bursa (bursa inflammation).
• Advantages:
D shorter recovery time.
D lower complication rate.
D better cosmetic results and wound healing.
Procedure:
• The patient is positioned prone, and two small portals are opened in the heel area.
• The surgeon cleans the bone bump using a shaver or burr, and inflamed tissues and fibrotic structures are debrided.
• The correct area is identified using a K-wire (wire) as a guide, and the bone bump is completely removed.
Used in cases of damage or adhesions in the Achilles tendon.
• Purpose: To clean the degenerative tissues and adhesions around the tendon.
• Advantages:
D Healthy parts of the tendon are preserved.
D The low complication rate due to its minimal invasive nature.
Procedure:
• Medial and lateral portals are opened to clean fibrotic structures and neovascular formations around the tendon.
• The degenerative tissue on the ventral surface of the tendon is completely removed.
In some cases, both Haglund deformity and chronic Achilles tendinitis may need to be treated together. In such cases, both calcaneoplasty and tendinoscopy are performed in the same session.
• Aftercare:
• Compression bandage or cast can be used postoperatively.
• Weight-bearing process increases gradually depending on the extent of the intervention.
The post-surgery recovery process depends on the patient's compliance with the treatment and the extent of the surgical intervention:
• First 2 Weeks: Leg elevation and ice application are performed.
• Weight-Bearing: Patients who underwent minimal debridement can bear full weight within 10-14 days, while for more extensive interventions, this period varies between 4-6 weeks.
• Physical Therapy: Post-surgical rehabilitation is necessary to increase range of motion and tendon endurance.
Endoscopic surgery offers advantages like a low complication rate and a rapid recovery process. Studies have shown the following results:
• Success Rate: Most patients have returned to pain-free movement and sports activities.
• Complications: Complications such as infection, nerve damage, and tendon rupture are rare.
Haglund deformity and chronic Achilles tendinitis can be successfully treated with surgical interventions. Endoscopic calcaneoplasty and Achilles tendinoscopy are at the forefront with low complication rates and rapid recovery processes. If conservative methods fail, these surgical approaches can be the key to a pain-free life and return to an active lifestyle.
